Introduction: Noninvasive vascular imaging, including CT and MR angiograms, have emerged as alternatives to traditional, catheter-based angiography for the assessment of cerebrovascular pathology given associated complications such as embolic stroke, retroperitoneal hematoma, and contrast allergy concerns. This has resulted in shifting trends in cerebral angiography use across institutions domestically over the course of the last decade.
Methods: We performed a retrospective cohort study involving all patients with a primary ICD-9 procedure code of cerebral angiography (88.41) within the National Inpatient Sample database from 1999-2009. Patient demographics, hospital subtype, admission source, complication rates, and procedural charges were analyzed.
Results: 424,105 inpatient cerebral angiography procedures were performed from 1999-2009 based upon NIS weighted estimates. Generally, there was a significant increase in mean procedural charges over the period of analysis, from $17,365 in 1999 to $45,339 in 2009 (p<0.001). No significant trend in utilization rates was noted across years (p=0.66). Most common complications included embolic stroke (3.8%), hematoma (1.3%), contrast allergy (0.14%), and contrast nephropathy (0.04%). Complications were more likely to occur in nonacademic institutions (p<0.001, OR 1.31, 95% CI 1.16-1.49) or in instances of admission via the emergency department (p=0.005, OR 1.15, 95% CI 1.04-1.27). There was a significant association between age group and risk of embolic stroke secondary to cerebral angiography, where those over the age of 55 years had a threefold higher risk versus the youngest subgroup (=17 years; p<0.001, OR 3.36, 95% CI 1.98-5.71).
Conclusions: The utilization of cerebral angiography has remained stable over the past decade while costs have risen. Complication rates seems significantly higher amongst the inpatient population greater than 55 years versus all other age groups, meriting consideration of alternative imaging modalities in such subpopulations. Based upon NIS projections, inpatient cerebral angiography has higher complication rates versus what has been previously published, likely secondary to patient selection bias.
Patient Care: This research highlights shifting trends in cerebral angiography use and understanding of associated complications. The advent of additional, noninvasive imaging modalities alters patterns cerebrovascular care across both academic and nonacademic institutions. This research also provides important data regarding complications and predictive associated risk factors, which should be considered prior to the performance of cerebral angiography.
Learning Objectives: By the conclusion of this session, participants should be able to 1) identify national trends over the past decade in the use of cerebral angiography domestically; 2) understand common complications and their rates related to cerebral angiography; 3) recognize factors associated with elevated complications rates (i.e., age, comorbidities); 4) appreciate discrepancies in cerebral angiography use in academic vs. nonacademic institutions; and 5) understand how improvements in noninvasive imaging have impacted angiogram utilization rates.